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AC) tfrO <br /> Nebraska..-. Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be riled with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> YWCA OF GRAND ISLAND ® Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 211 E FONNER PARK RD HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City State,Tip Code <br /> -7-'‘CC- r - C ni Q IR C t' t•C eA;X bee_ C C1 t'Z�.-Sa'-lit�-kl fe2c 1 <br /> Iss Js? C1-. n -teat h. k�:per Gcfnrd.1.skas ] t- bwAcs <br /> '-d P T m,' 7IPLAne. I60q n'lr�rfn,.-) Qd ar,.Ark II>its: s.r< t (OPS03 <br /> 3a k.iP a‘nneScent.carl I eas 2.11- 4ics Sy. l`.1'JGr.a ®L. C6®'72 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Motor Vehicle Make Rstrtion <br /> Motlel Year I Body Type Vehicle!D Number I Da ofaAcqusiton, <br /> t— / /� �^ �/� if Newly Purchased <br /> Yore zaz CYJn06e tdon /f1 5S3 /Zo32/143, <br /> Ord /596 ki Vl in mr.g//Ai9741IM,Cd,S__7 <br /> Exempt Uses of Motor Vehicle: ,p-� {�-,( Are the motor vehicles used exclusively <br /> ❑AgriculturalMortcultural I EO Educational ❑Religious D(I Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ^ 1(YES ❑NO <br /> 1'(css�g�0,(--4t0-.\--10,y v� �. ^ OVk 0211 If No,give percentage of exempt use: <br /> IS <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge and belief,true,complete,and correct I <br /> also declare that I am dul authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership or emr - ent based on race,color,or national origin. <br /> / ' <br /> sig 7 t ..� �A_ I� 'inhi <br /> `ice ii. <br /> he e Authorized 5:nature Title / Date <br /> FOR COUNTY TREASURER RECOMMENDATION I <br /> APPROVAL RECEIVED COMMENTS: A% e A5.,5 ' 77- g° <br /> ❑DISAPPROVAL <br /> NOV 2 O 2014 /=9-%5 <br /> /Signature of unty Treasurer Date <br /> I HALE FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND,NEBRASKA <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> 4 fl4 /— 4315 <br /> ., od.-d S'.' : re Date <br /> Nebraslas Department of Revenue Authored by Nob.Rev.Slat§$77.202(1)(c)and(e),and 608.185,and 80-9,189 <br /> 98-253.2006 Pea.5-2011 Supersedes 96-258-2006 Rev..5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br /> • <br />